Agreement for Worksafe and TAC approved sessions

Welcome

Thank you for choosing The Biomechanics. To help us process your WorkSafe Victoria or TAC claim and arrange your appointment as quickly as possible, please complete the form below.

The information you provide will assist our team in confirming your funding approval, collecting the necessary claim details, and ensuring we have everything required before your first appointment. This helps minimise delays and allows our clinicians to focus on your recovery from day one.

If you are unsure about any of the questions or don't have all the required information please call us on 1300 920 520.

Your details:

First name *

Last name *

Date of birth *

Email address *

Mobile number *

Preferred Clinic *

Footscray: Level 2, 109-111 Nicholson street FootscrayPort Melbourne : Suite 9, 11 Beach street Port MelbourneGlen Iris : Suite 4, 1463 Malvern road Glen Iris

About Your Case and Services.

What scheme are you receiving funding through? *

TACVictoria WorkSafe Interstate Worksafe

Which WorkSafe Agent manages your claim? (eg, EML, Allianz, Gallagher Bassett etc) *

Your claim number: *

Date of Injury or accident *

Claims Officer or Coordinator Name *

Claims officer or Coordinator Email address or Phone number *

What service/s are you covered for? *

Exercise PhysiologyPhysiotherapy

When does your coverage expire (if known)?

How many sessions do you have approved (if known)?

Do you have a current GP referral to see an Exercise Physiologist? *

YesNo

Please make sure that your GP has sent this referral to your case manager or insurer as your services are not able to be funded without this referral.

Please upload any documents you already have.

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To help us provide the best possible care, please note the following:

Appointment Changes: We understand that life happens! If you need to cancel or reschedule your appointment, we kindly ask for at least 18 hours' notice. Appointments cancelled within 18 hours or not attended may incur the full consultation fee.
Reports & Forms: To ensure our clinicians can dedicate the appropriate time to your care, any reports, forms or certificates are completed during your scheduled appointment .
WorkSafe & TAC Clients: Please ensure your claim has been approved and all relevant claim details have been provided before your appointment. If approval is still pending, your consultation may need to be privately funded until authorisation is received.
Arriving for Your Appointment: We recommend arriving a few minutes early to allow time for check-in. If you arrive late, we will do our best to see you; however, your appointment may need to be shortened to avoid delaying other clients.
Questions? If you're unsure about your funding, referral or appointment, our friendly team is always happy to help before you attend. 1300 920 520 and ask for the Adminstration team.

Your agreement with The Biomechanics:

Consent *

I confirm the information provided is accurate.I consent to The Biomechanics contacting my insurer, employer, treating doctor and other healthcare providers where required to assist with my claim.I understand all WorkSafe/TAC approvals must be in place prior to my appointment.I understand cancellation fees may apply if I cancel within 18 hours or fail to attend. These fees cannot be billed to WorkSafe or TAC and may become my personal responsibility.I consent to The Biomechanics collecting and storing my personal information in accordance with its Privacy Policy.

Please Sign *

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